Health Insurance Surveyor

5 days ago

Raipur Chhattisgarh, India nirvana_association Full time

A **Health Insurance Surveyor** (also known as an Insurance Claims Surveyor or Assessor) is responsible for inspecting, assessing, and verifying insurance claims related to medical treatments and hospitalizations. Their job involves evaluating the validity of claims, ensuring compliance with policy terms, and preventing fraud.

**Job Description (JD) for a Health Insurance SurveyorJob Title**: Health Insurance Surveyor / Claims Assessor**Location**: [Company-specific or Remote]**Job Type**: Full-time / Contract / Freelance**Roles & Responsibilities**:

- **Claims Assessment**:

- Inspect and verify medical claims submitted by policyholders.
- Assess hospital bills, treatment details, and supporting documents.
- Ensure the claim falls within the policy coverage.
- **Medical Investigation & Verification**:

- Coordinate with hospitals, doctors, and patients for claim verification.
- Check for discrepancies, overcharging, or fraudulent claims.
- Cross-check medical reports with the claimed treatment.
- **Documentation & Reporting**:

- Prepare detailed survey reports with findings and recommendations.
- Document claim approval or rejection reasons.
- Maintain accurate records of claims processing.
- **Compliance & Fraud Prevention**:

- Ensure adherence to insurance regulations and company policies.
- Identify fraudulent claims and report suspicious activities.
- **Communication & Coordination**:

- Liaise with policyholders, healthcare providers, and insurance companies.
- Provide explanations regarding claim settlements or rejections.
- Guide policyholders on claim processes and required documentation.

**Key Skills & Qualifications**:

- Bachelor's/Master’s degree in Medicine, Insurance, or related field.
- Certification as an Insurance Surveyor (if required by regulatory bodies).
- Knowledge of health insurance policies, claim procedures, and medical terminology.
- Strong analytical and investigative skills.
- Excellent communication and report-writing abilities.
- Familiarity with insurance software and digital claim processing.

**Experience**:

- Freshers with relevant qualifications can apply.
- Experience in claims assessment, medical auditing, or insurance underwriting is a plus.

**Salary**:

- Depends on experience, company, and location. Generally ranges from for freshers and mid-level professional

Pay: ₹45,000.00 - ₹50,000.00 per month

**Benefits**:

- Cell phone reimbursement

Schedule:

- Day shift

Supplemental Pay:

- Yearly bonus

**Experience**:

- Health insurance surveyor: 3 years (required)
- Automobile insurances surveyor: 3 years (required)
- Insurances surveyor: 3 years (required)

Work Location: In person

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